Membership renewal 2010

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Pacific Coast Corvette Club Membership Renewal Form

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Membership renewal 2010

  1. 1. MAIL  TO:    Pacific  Coast  Corvette  Club   PO  Box  14   Coos  Bay  OR  97420     MEMBERSHIP  RENEWAL     Dues  are  $30  per  year  per  household  (couple)   Renewals are due by March 1, 2010 or your name will be omitted from the membership list. I/We   hereby   renew   my/our   membership   in   the   Pacific   Coast   Corvette   Club   in   the   classification   indicated   above.     I/We   agree   to   abide   by   the   Constitution   and   Bylaws   of   the   Club   and   regulations   governing   its   operation  as  adopted  by  the  membership.     NAME:  ______________________________________________________________Birthday  &  Month  _________________   ADDRESS:  ____________________________________________CITY:  ________________  ZIPCODE  _________________   SPOUSE/OTHER:  ___________________________________________________  Birthday  &  Month  ______________________   HOME  PHONE:  ___________________________FAX:  ___________________________CELL:  ________________________   BUSINESS  PHONE:  ____________________________________  (   EMAIL  ADDRESS:  _____________________________________________________   Do  you  want  your  phone  number  to  be  published  for  others  to  see?    YES  __________  NO  _____________     CORVETTE  INFORMATION     MODEL:  _______________________________COLOR:  _______________________  YEAR:  _________________   SPECIAL  FEATURES:  __________________________________________________________________________   MODEL:  _______________________________COLOR:  ________________________YEAR:  ________________   SPECIAL  FEATURES:  _________________________________________________________________________     SIGNATURE  OF  APPLICANT  ____________________________________________________________________     Please  return  this  form  and  your  check  to  the  address  above.  Thank  you.  

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